Provider Demographics
NPI:1346435807
Name:COSTEN, NANCY LYNN (APNP/RN/MSN)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:LYNN
Last Name:COSTEN
Suffix:
Gender:F
Credentials:APNP/RN/MSN
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:LYNN
Other - Last Name:MURPHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APNP/RN/MSN
Mailing Address - Street 1:901 DULANEY VALLEY ROAD, SUITE 110
Mailing Address - Street 2:
Mailing Address - City:TOWNSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204
Mailing Address - Country:US
Mailing Address - Phone:410-296-3104
Mailing Address - Fax:410-296-3184
Practice Address - Street 1:4532 I-30
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150
Practice Address - Country:US
Practice Address - Phone:214-324-8625
Practice Address - Fax:214-324-8629
Is Sole Proprietor?:No
Enumeration Date:2007-09-07
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP128186363LA2200X
WI3140-033363L00000X
WI114204-030363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI36044500Medicaid
710180749Medicare UPIN